Now that nearly all of the nation's hospitals and the vast majority of its office-based physicians have adopted electronic health record systems, the focus has shifted to getting these disparate systems to exchange patient information.
Surescripts has been at the center of the push for health data-sharing. The private health information exchange network, formed in 2008 with the merger of two rival e-prescribing networks, is jointly owned by two pharmacy trade groups—the National Association of Chain Drug Stores and the National Community Pharmacists Association—and pharmacy benefit management companies CVS Health and Express Scripts. Surescripts recently reported it handled 9.7 billion electronic transactions in 2015—48% more than the previous year.
Modern Healthcare health IT reporter Joseph Conn interviewed Surescripts CEO Tom Skelton about the role of e-prescribing in achieving meaningful interoperability. This is an edited transcript.
Modern Healthcare: The volume of e-prescribing has increased 300% since 2010 to 1.4 billion scripts in 2015. Is that interoperability?
Tom Skelton: Absolutely, that's interoperability. That is connecting a pharmacist electronically with a physician for the betterment of patient care. That's exactly what interoperability is all about. It's connecting two providers to improve patient outcomes, to increase efficiency. I think there are 10 billion proof points out there that say the industry is moving, that the combination of private industry effort with regulatory guidance and pressure is leading to a much more interconnected and digitized healthcare system.
MH: Medication reconciliation messages—messages containing medication histories—grew from 747 million on your network in 2013 to 1.05 billion in 2015. That's a lot of communication on a real tough problem. Where are we heading on that?
Skelton: I think that growth is because people see value and realize that this type of opportunity is in the market. Now, if you've ever had the opportunity to take a loved one to the hospital, it's always a very interesting and challenging event. I had my mother there not long ago and they asked her, “So, what meds are you on?” And you're getting answers that are color-driven. “I take two red ones and a blue one. I take those in the morning. Then in the afternoon I take a white one.” And then she can describe the conditions but not necessarily the meds that she's taking. And that uncertainty takes a lot of time to deal with and it creates risk and potentially leads to incorrect care. What we think the market is realizing, is that by having all this medication history online and readily available—with a quick turnaround, from a trusted source—that they can deliver better care and they can do it very efficiently for their own business. If they don't get it from us, then somebody in nursing or some other clinician has to sit down with my mother and ask all of those questions directly. It's just a much less efficient and effective way to do it.
MH: There was also substantial growth in clinical messages.
Skelton: This is an example of something that was built into some of the (federal) meaningful-use criteria. It started off a little slowly. I think the way that it was envisioned to work was never really the use-case that the market was hoping for. Over the past couple of years we've started to work very closely with clinicians and started to change the way we're using this tool set to deliver data. This is another example of where you start an initiative and it just takes time to build momentum, for people to recognize the value, and to make it part of their own offering inside their facilities.
MH: Are these C-CDA (consolidated clinical documentation architecture) summaries?
Skelton: That's exactly right. We think clinical messaging is kind of the push of clinical interoperability, meaning I'm seeing a patient, I recognize that someone else in the care-delivery team needs to see the information, and at that point in time I either push it to another clinician or I can push it back to the patient so they've got it as part of discharge information. But it is the attending physician, at that point in time, or someone on that team that makes the decision to share and push it out to others on the team. Surescripts' National Record Locator Service is the other side of that coin. That's the attending physician, saying, “Boy, I'm seeing this patient. I wish I had more information on that. Can I query the system nationwide and see where this patient has been seen?” And then if I see something interesting by locating the records, then I can double-click on that, drill down and have those records sent.
MH: You have about 1.07 million professionals in the Surescripts directory, but anyone who's done any work with databases knows that the information that you enter this second may not be relevant 10 seconds later. Can you tell us a little about this professional directory and how you keep it current?
Skelton: You absolutely have highlighted one of the great challenges in managing the network, and that is understanding who is a trusted healthcare professional, where they practice medicine, and what rights and privileges they have associated with the network. These updates are going on constantly. And a lot of the updates are very simple updates—Dr. Smith has always practiced at 123 Main St. and she just opened a new facility right around the corner on Elm Street and so now we need to know that the same Dr. Smith is in both locations. And we have to be able to take that data in, recognize that there's a pattern that's changing here, and make sure that the directory is updated. We refer to that as a learning directory, so it is constantly checking itself and messaging back to other people here in the organization so that we can stay on top of this and keep this up to date. It is absolutely a challenge and making sure that that database is accurate and appropriate is a huge piece of what we do with our infrastructure.